Treatment of Transverse with or without Posterior Wall Fractures of Acetabulum Using a Modified Smith-Petersen Combined with Kocher-Langenbeck Approach

Abstract

BackgroundThe aim of this study was to explore the surgical treatment of transverse with or without posterior wall fractures of the acetabulum.Material/MethodsWe surgically treated 21 consecutive cases of pure transverse (7 cases) and with posterior wall (14 cases) fractures of the acetabulum. The anterior column fractures were firstly reduced, temporarily fixed through a modified Smith-Petersen small incision, and finally fixed after the fixation of the posterior column and wall fractures, which were reduced and fixed through a Kocher-Langenbeck approach. The operative time, intra-operative blood loss, quality of reduction (Matta criteria), perioperative complications, osseous union, subsequent complications, and hip function evaluation were recorded.ResultsThe mean operative time was 198.1 min and the mean intra-operative blood loss was 938.1 ml. Anatomic reduction of the anterior column was obtained in 20 cases and was imperfect in 1 case. All posterior column and wall fractures were anatomically reduced. We followed up 18 cases for a mean duration of 16.3 (8–30) months. All the fractures achieved osseous union. The mean Harris score was 85.1 points, with an excellent result in 7 cases, good in 8, fair in 2, and poor in 1. According to modified Merle d’ Aubigne and Postel score system, the results were excellent in 2 cases, good in 15, and poor in 1. Avascular necrosis of the femoral head occurred in 1 case, heterotopic ossification in 3 cases, and numbness of the anterolateral thigh in 6 cases.ConclusionsFor transverse with or without posterior wall fractures of the acetabulum, reduction and fixation of anterior and posterior column should be done in sequence, and a modified Smith-Petersen small incision might be a good choice in reduction and fixation of the anterior column because it possesses advantages of direct visualization and minimal invasion.

A Novel Anatomical Locking Guide Plate for Treating Acetabular Transverse Posterior Wall Fracture: A Finite Element Analysis Study

“…On the basis of the Judet and Letournel classification for acetabular fractures, 2 , 12 ATPWF was reconstructed as previously described. 13 , 14 Briefly, given that ATPWF includes two types of simple acetabular fractures: transverse fracture and posterior wall fracture, we respectively reconstructed these two fractures. For the transverse fracture, the fracture line started from the upper margin of iliopubic eminence to the top of the greater sciatic notch.…”

The Kocher-Langenbeck approach combined with robot-aided percutaneous anterior column screw fixation for transverse-oriented acetabular fractures: a retrospective study

“…The simple posterior plating probably leads to opening of the anterior fracture gap due to the unreasonable pre-contouring of the plate or failure of anterior reduction. Consequently, the K-L approach combined with an anterior fixation for transverse acetabular fractures is recommended to achieve anatomical reduction and stable fixation [ 12 ]. The stiffest fixation method for the TOAFs shown in the clinical and biomechanical studies is the combination of posterior column plates with an anterior column screw, with loss of reduction ranging between 3 and 5% [ 13 – 15 ].…”